Abstract
Therapeutic communities (TCs) are becoming increasingly widespread as a form of treatment for entrenched mental health problems, particularly addictions and personality disorders, and are equally used in educational, prison and learning disability settings. Despite growing evidence for their effectiveness, little research has been conducted to establish how TCs work to produce positive outcomes. We hypothesize that there are two specific factors that in combination contribute to TC effectiveness: the promotion of a sense of belongingness and the capacity for responsible agency. Although both factors are found in other therapeutic approaches and are important to the psychosocial aspects of psychiatric care more generally, we argue that their combination, extent and emphasis are unique to TCs. Drawing on social and experimental psychology, we: (1) review research on a sense of belongingness and the capacity for responsible agency; (2) establish the mechanisms by which TCs appear to promote them; (3) draw lessons for TC practice; and (4) suggest why they may contribute to positive outcome. A sense of belongingness is correlated with improved self-esteem and overall well-being. The capacity for responsible agency is central to behavioural change. TCs are typically used in fields where positive outcome requires both personal growth and behavioural change. We suggest that TCs are uniquely placed to demand such growth and change of their members because the sense of belongingness engendered by TC methods protects against the risks engendered by this demand. Empirically informed, evidence-driven research is necessary to understand how TCs work and how TC practice can be improved. This understanding may offer lessons for the improvement of psychosocial aspects of psychiatric care more generally.
Highlights
Psychotherapeutic approaches are generally understood to comprise both non-specific and specific factors that contribute to positive treatment outcome
Most substantially, we propose two specific psychotherapeutic factors in Therapeutic communities (TCs) that we suggest contribute to positive outcome: the promotion of a sense of belongingness and the promotion of responsible agency
Both factors can be found in other psychotherapeutic models to a degree; but we suggest that their combination, extent and emphasis are unique to TCs
Summary
Psychotherapeutic approaches are generally understood to comprise both non-specific and specific factors that contribute to positive treatment outcome. Until research is undertaken to test this hypothesis, we cannot know that it is precisely these factors, in combination or singly, that contribute to the positive outcome of TCs. Quite generally, we hope that our proposal may spur empirically informed, evidence-driven research on TCs. More we hope our discussion spurs research on the extent to which a sense of belongingness and responsible agency, in combination or singly, is augmented through TC treatment in contrast to other psychotherapeutic models. We hope our discussion spurs research on the extent to which a sense of belongingness and responsible agency, in combination or singly, is augmented through TC treatment in contrast to other psychotherapeutic models In our view, this is a key step to achieving a better understanding of how TCs are effective and, correspondingly, how TC practice can be improved. An example question on belongingness from this scale is: ‘These days other people care about me.’ They found an association between thwarted belongingness and suicidal ideation
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